Peyronies
Disease

Men with Peyronies disease generally seek medical attention for pain
or bending of the penis during erection, which results from
inflammation and scarring in a particular part of the male anatomy
known as the tunica albuginea.

Francois de la Peyronie, surgeon to Louis XIV of France, first
described treatment for this disorder in 1743.

This condition is most commonly acquired at about age 55. A man
can be born with curvature of the penis, though this is not Peyronies
disease.

Severity varies - only a minority of the men afflicted with this
problem are unable to engage sexually. Through an effect on the
erection mechanism it can reduce rigidity (hardness), but it rarely
causes impotence.

It is somewhat uncommon, affecting somewhere between one and three
men in a hundred.

In addition to producing curvature, Peyronies disease may change
the shape of the erection in other ways: indentation, diameter
reduction, or loss of length.

Peyronies disease can have a strong psychological impact.

Some cases are mild, healing without treatment within a year of
onset. Most cases produce at least some degree of persistant
curvature.

A noticeable lump, or plaque within the penis is commonly
detected. Contrary to prevalent anxieties, it is noncancerous, and
unrelated to cholesterol  containing arterial plaque

Peyronies disease can run in families, though most cases do not
appear to be hereditary.

This condition is not associated with serious internal disorders.
10 20% of men develop scarring of either the hands
(Dupuytrens contractures) or of the feet.

The goal of therapy is to maintain sexual function. In some cases,
education about the disease and reassurance is all that is required.
Rarely, when long-term deformity prevents intercourse, surgery is
recommended.

Beginnings

The cause of Peyronie's disease is not well understood.
Nonetheless, research findings that shed light on this question are
of interest to patients as well as to medical scientists.

Consider a more specific question: What causes the erect penis to
bend? The answer lies in the functioning of the erection mechanism,
the corpora cavernosa. These cigar shaped, paired balloon-like
chambers must inflate with blood to create an erection. Their
connective tissue wall, or tunica albuginea, produces rigidity only
when maximally stretched. It is elastic to a point, but unlike the
flimsy wall of a balloon, tunica albuginea is interlaced with strong
connective tissue fibers. These fibers control expansion, determine
the shape of the erect penis, and translate internal filling into
structural rigidity.

Peyronies disease is a disorder of the tunica albuginea. By
producing firm areas, or plaques, it focally interferes with the
expansion of this normally pliant material. Plaques can be either
regions of reversible inflammation in early phases of the disease, or
permanent scars later on. Regardless of their composition, they alter
the shape of the distended corpora cavernosa and distort the
resulting erection. Like a piece of cellophane tape on the wall of a
balloon, they cause uneven inflation and bending out of column.

The real question is, what produces these plaques? Early on as
painfully swollen patches of inflammed tunica albuginea, or later in
the disease as the site of inelastic and permanently disfiguring
scars, they are at the heart of the problem.

Microscopic and chemical studies have shown that plaques represent
stages in the wound healing process, whether early or late. Whatever
brings on Peyronies disease appears to do so by inappropriately
turning on this normally healthful process.

More accurately, wound healing may not be inappropriate in all
cases. We know that one cause of Peyronies disease is overt trauma to
the erect penis. This can range from painful unexpected angulation
during sex, to actual rupture of the corpora cavernosa, an even that
produces immediate loss of the erection and subsequent severe
swelling. The fact is, most men with Peyronies relate no such
occurences.

Probably, all sexually active men experience some degree of wear
and tear on particular vulnerable areas of the erection mechanism.
Both the structural arrangement of the corpora and the inherent
elasticity of its connective tissues counteract the strong mechanical
stresses imposed by active intercouse. But by the time men reach
their mid fifties, inherent connective tissue elasticity is on the
wane. The median age for the appearance of Peyronies disease is
fifty-five.

Peyronies plaques most commonly appear along the top of the penis.
It is this region between the paired corpora, along the upper edge of
the "inflatable I-beam"created by their inflation, that is vulnerable
to stress-induced delamination . This is the region where fibrin, a
protien involved in activating wound healing, can be found in men
with Peyronies disease.

Autopsy studies on men have shown that the earliest microscopic
changes thought to be evidence of Peyronies disease are actually a
common finding. Though many men develop these changes, they evolve
into Peyronies plaques in a very small percentage of cases. So what
causes normal wear and tear to abnormally activate wound healing? At
this point there is no clear answer. Peyronies disease is more common
in diabetics and in men with gout, two condtions that can affect
connective tissue healing. It is also more common in the presence of
Dupuytrens contractures. These scars of the fascial covering of
the finger tendons in the palm of the hand can be inherited, and may
reflect an abnormal tendency toward scar formation in other
areas.